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A Prescription for Unpleasant Side Effects?

A cadre of influential state senators from South Florida is pushing a
bill that would expand prescription drug benefits for the elderly. Pharmacists,
however, say the increase in benefits could put them out of business.

Tom Rossin, D-West Palm Beach, leader of the Senate Democrats, is sponsoring
the measure, which came out of the Health, Aging and Long-Term Care Committee
in the Florida Senate.

The Florida Legislature established a program last year with $15 million.
About 30,000 people in Florida make use of the benefits. The assistance
program helps low-income elderly or disabled people whose prescription
drug expenses fall between the cracks of Medicare and Medicaid coverage.

Rossin's bill is one of several variations in the Florida House and Senate
this session on the discount drugs theme. But it is the bill that carries
the most clout, says one legislative insider who asked not to be identified.
While the money needed to fund the program's expansion isn't in the Senate's
$48 billion budget, "there's a lot of horsepower in that group of senators."

Florida is one of more than 20 states to establish some form of subsidy
to help seniors pay for outpatient prescription drugs.

Florida limits benefits to $80 a month. Rossin's bill would up that to
$150 a month and raise the income eligibility level from 120 percent to
150 percent of the federal poverty line. Pharmacists are watching the
bill closely, arguing that increasing the benefits could put them out
of business.

Some pharmacists say the proposal is no better than price fixing.

"This all boils down to a ceiling being placed on the cost of prescriptions,"
said Michael Jackson, executive vice president of the Florida Pharmacy
Association in Tallahassee. The FPA counts 3,343 pharmacists as members.
There are about 20,000 Florida licensed pharmacists.

Another provision in Rossin's bill cuts out a requirement that now limits
the program to Medicaid participants. If that amendment remains intact,
100,000 people could become eligible for the program, the committee estimates.

Rossin's bill would add $259.2 million a year to Florida's Medicaid budget,
which already is operating $1 billion in the red. That's why few in Tallahassee
give the bill much chance in this cut-spending-to-the-bone session.

But the bill isn't buried yet. Rossin has won the support of other veteran
Democratic legislators in the state Senate, including Boca Raton's Ron
Klein and Broward County state Sens. Steve Geller from Hallandale Beach
and Tamarac's Walter G. "Skip" Campbell Jr.

Klein and Campbell are on the health care committee, along with South
Florida Democratic Sens. Debbie Wasserman Schultz from Pembroke Pines
and Fort Lauderdale's M. Mandy Dawson, who serves as vice chair.

The committee acknowledges that some pharmacists would see a drop in
profits from the sales of certain outpatient prescription medicines. However,
the committee predicts that any loss in profits would be offset from increased
sales to the additional customers.

Jackson is skeptical of that prediction. "Increasing the number of participants
means there may be individuals currently doing business with a pharmacy
who will become eligible to receive this assistance," he said. "What you're
doing is expanding the number of patients eligible for this program to
people who have too much money to qualify for Medicaid."

The committee report warns that pharmacies and drug manufacturers would
increase prices for people without benefits to make up for any profit
drop.

"That's probably correct," Jackson said. There's a cap on certain segments
of the prescription market. Typically 70 percent of a pharmacy's business
is through some sort of managed health care program such as an HMO or
Medicare, he said. Those plans dictate what type of reimbursement the
pharmacy can get. The rest consists of free-market, cash customers.

"They're taking that 30 percent of free-market customers and adding further
caps to some of that business," Jackson said. "And that's what a pharmacist
may say is price fixing."

A companion bill in the Florida House is sponsored by Rep. Susan Bucher.
The Democrat from West Palm Beach is on her first term, but she has more
savvy than most freshman legislators because she was an aide to the late
Rep. Ed Healey for several years.

But Bucher is not optimistic about the bill making it through the maze
of committees it has to hurdle, even though she sits on one of them in
the House, the Health Promotion Committee.

"We all campaigned on this issue, Democrats and Republicans, but there's
not a lot of emphasis in the House on it and I can't get my chairman [Republican
Rep. Ken Litttlefield from Zephyrhills] to move it."

Last month, the Florida Senate's bipartisan health care committee of
six Republicans and five Democrats unanimously passed the bill. It's now
in a holding pattern with the Governmental Oversight and Productivity
Committee in the Senate.

And while Rossin's bill is moving, "if mine dies, his dies," Bucher said.
In that case, the best chance to get the job done is to add proviso language
to the budget.

That strategy has a lot of "ifs" to it.

The Florida House budget is $53.5 billion, the Senate's $47.8 billion.
The two chambers have to work out a single budget before the session ends
May 4. That task is done through conference committees.

"If they don't pass a tax break bill, we'll have $355 million to add
to the budget," Bucher said.

Given that scenario, the conferees could add proviso language that would
in effect change the eligibility requirements. "So the content of our
bills would be in the budget.

Legislators funded the program last year with $15 million. That was doubled
under Gov. Jeb Bush's executive budget by tapping the Tobacco Settlement
Trust Fund.

Ideally the FPA wants to bundle the various bills into a single package.
"We're actively working with Sen. Rossin to come up with a consensus to
provide some relief to our seniors and yet not put pharmacists out of
business," Jackson said.